顺式阿曲库铵闭环肌肉松弛注射系统在胸腔镜手术中的应用  

Application of cisatracurium by closed-loop muscle relaxant injection system in thoracoscopic surgery

作　　者：李冰[1] 薛纪秀[1] 叶新[1] 马艳辉[1] 尹橙[1] 阎雁宏[1] 

机构地区：[1]首都医科大学宣武医院麻醉科,北京100053

出　　处：《上海医学》2014年第10期835-838,共4页Shanghai Medical Journal

基　　金：首都临床特色应用研究资助项目(Z12110700102160)

摘　　要：目的研究闭环肌肉松弛药注射系统（CLMRIS）对药物剂量和患者肌肉松弛恢复情况的影响。方法选择行胸腔镜手术患者20例,随机分入闭环注射组和对照组,每组10例。对照组患者维持静脉注射顺式阿曲库铵1.5~2.0μg·kg^-1·min^-1,此时肌肉松弛最大抑制程度,即4个成串刺激（TOF）中的第1个肌颤搐值（T1）能达到89%~99%,直至手术结束前30min;闭环注射组患者应用CLMRIS,顺式阿曲库铵的最小背景剂量为0.08μg·kg^-1·min^-1,设定肌肉松弛深度反馈值T1为25%。记录患者的麻醉时间、手术时间、顺式阿曲库铵总用量、TOF从0.25恢复至0.75的时间[TOF中的第4个肌颤搐值（T4）与T1的比值（TOFR）0.75恢复时间]和TOF从0.25恢复至0.90的时间（TOFR 0.90恢复时间）。结果闭环注射组的顺式阿曲库铵总用量显著少于对照组（P〈0.05）,T1从25%恢复到75%的时间、T1从25%恢复到95%的时间、TOFR0.75恢复时间和TOFR 0.90恢复时间均显著短于对照组（P值均〈0.05）。结论与推荐剂量持续静脉输注方式相比,闭环肌肉松弛药注射方式可以满足胸腔镜手术中的肌肉松弛要求,减少肌肉松弛药的用量,缩短肌肉松弛T1从25%恢复到95%的时间,实现肌肉松弛药个性化和合理化使用。Objective To explore the effect of closed-loop muscle relaxant injection system on the dosage of muscle relaxant and neuromuscular recovery. Methods Twenty patients scheduled for thoracoscopic surgery were enrolled in this study and randomly divided into two groups （n = 10） ： closed-loop injection group and control group. The dose of cisatracurium was maintained at 1.5- 2 μg · kg^-1 · min^-1 in the control group until 30 minutes before the end of surgery. Meanwhile, the first myopalmus （T1, the maximal depression of muscle relaxation） could be kept between 89% and 99%. The background dose of cisatracurium was set at 0.8 μg · kg-^1· min-^1 in the closed-loop injection group and the feedback value of muscle relaxation depth was 25%. The duration of anesthesia and surgery, cisatracurium consumption, recovery index （RI）, recovery time, the ratio of the fourth myopalmus to the first myopalmus （TOFR） 0.75 and TOFR 0.90 were recorded. Results The total amount of cisatracurium in the closed-loop injection group was significantly less than that in the control group （P〈0. 05）. Recovery time, RI, TOFR 0.75 and TOFR 0.90 in the closed-loop injection group were also significantly less than those in the control group （all P〈0.05）. Conclusion Compared to the continuous infusion, the closed-loop injection system can meet the muscle relaxant requirements during thoracoscopic surgery, decreasing the dosage of muscle relaxants and recovery time, and personalizing and rationalizing the muscle relaxant usage.

关 键 词：肌肉松弛监测 闭环肌肉松弛注射系统 肌肉松弛推荐剂量持续输注方式 顺式阿曲库铵 胸腔镜手术 

分 类 号：R614[医药卫生—麻醉学]